Size matters: experiences of larger families on a low income during COVID-19

Background Despite recognition that social determinants are critical to health outcomes, many groups, including those with lower incomes, racial/ethnic minorities, and other historically marginalized populations, continue to experience significant social and structural barriers to care. There is need for research that incorporates patient and stakeholder engagement in developing, testing, and disseminating interventions to improve outcomes for patient populations that have been marginalized in the health system. Patients who use a language(s) other than English (LOE) for healthcare communication are at increased risk for experiencing adverse events and worse health outcomes in healthcare settings, including in paediatric hospitals. Canadian census data indicates 12.7% of Canadians predominantly speak a language other than French or English. This work aims to generate knowledge to improve health outcomes for children and families who speak LOE. Objectives (1) To understand the lived experience of families who speak LOE around the hospitalization of their child and (2) To understand the perspectives of patients and families who speak LOE on how the healthcare system can improve care during hospitalization. Design/Methods The premise of this study is participatory research. We designed a qualitative study involving children hospitalized in the General Paediatric Inpatient Unit at the Hospital for Sick Children. The study includes family caregivers of children age 0 to 18 years who identify as speaking LOE. Children and families could speak any language that we were able to obtain interpreter support for. We excluded patients that spoke a traditional Indigenous language as we noted this work required a separate study in partnership with the Indigenous community. We conducted semi-structured virtual individual interviews with children and families post-discharge with a medical interpreter. An interview guide was developed and transcripts were analyzed using thematic analysis. We took several steps to ensure an effective study design given our goals of participatory research including ensuring patient and family engagement throughout the design process. Results 19 families participated in the interviews and 16 different languages were represented amongst our participant groups. Our study is unique in especially unique in it's ability to recruit and interview individuals with so many different primary languages. Our study provides rich insight into opportunities within the paediatric inpatient setting for quality improvement to address the health disparities experienced by patients and families who use LOE for healthcare communication. Our analysis of the interviews identify several themes that provide insight into the lived experience of patients and families who use LOE for healthcare communication. 1) Inconsistent interpreter use affects communication “in the moment” and the ability to develop an “overall understanding” of the current clinical situation and broader healthcare context. Our participants note a "snowball effect" when interpreters are not consistently utilized. 2) In addition to language, multiple additional social factors contribute to an increased sense of vulnerability and modulates how families “trust” the healthcare system. 3) Despite families expressing positive experiences, they noted that they did not, nor expect to feel like they “belonged” within the healthcare system. It is critical to recognize the complex interplay between many factors surrounding our participants’ identities. Though they use a LOE for healthcare, the intersectional marginalization they experience was thoroughly represented during our conversations Conclusion Our research aimed to take a participatory approach to consider the lived experience of patients and families who use LOE for healthcare communication. This work builds on the current literature on patient and family centered care, experiences of families who speak LOE and participatory community-based research in the paediatric hospital settings. Our study's findings support the development of a research and intervention agenda in Canada to improve health outcomes for patients and families with LOE.

Our methodological approachWe draw on quantitative and qualitative evidence generated as part of the Benefit Changes and Larger Families research project.This project is investigating the two-child limit and the benefit cap, both key 'welfare reforms' that have significantly affected larger families.For the quantitative analysis presented here, we draw on individuallevel data throughout the pandemic from Understanding Society (the UK Household Longitudinal Survey), a high-quality panel survey based on probability sampling (University of Essex, Institute for Social and Economic Research, 2021a, 2021b).We use regular monthly and quarterly data from Waves 1-8 of the COVID-19 survey over the period April 2020 to March 2021 and match respondents longitudinally to pre-pandemic data from Wave 10 of the main survey (based on fieldwork from 2017 to 2019). 1 Longitudinal weights are applied to correct for non-response and are customised versions of those described in Benzeval et al (2021). 2 We use this survey data to track and compare outcomes for four distinct groups, by family size and receipt of means-tested social security benefits.This enables us to separate out the contribution of family size and income to the experiences of families with children during the pandemic.We use means-tested social security benefits as a proxy for low income because this is the mechanism through which the two-child limit and benefit cap are implemented. 3Segmenting our quantitative sample by social security status thereby enables us to integrate insights from our qualitative and quantitative research.We also draw on early interviews conducted as part of ongoing qualitative longitudinal research for the Benefit Changes and Larger Families project.This research explores how families are impacted by the two-child limit and the benefit cap, and how they respond to these policy changes, by interviewing 44 parents or carers three times over the course of 18 months.The research takes place in Bradford, London, and York.As this project focuses on larger families, our sample is composed of parents or carers with three or more children who are subject to either the benefit cap or the twochild limit, or both.To obtain in-depth data relevant to the participants' experiences of these welfare reforms, we conduct semi-structured individual interviews.The interviews uphold good ethical practice and particular attention is paid to informed consent, confidentiality, and anonymity, prevention of harm (for example, though handling participants' accounts sensitively), and reciprocity.This chapter reports on findings from the first 12 interviews.All of these interviews were conducted by telephone due to COVID-19 regulations.

Phenomenological analysis was used to understand how rural low-income families accessed and used child-care resources to meet the needs of their families using data from Wave 1 of the Rural Families Speak Project. In the aftermath of welfare reform, results highlight the continuing need for policy aimed at building stronger supports for families with inadequate access to child care. Key Words: child care, low-income, phenomenology, policy, rural families, welfare reform. (Family Relations, 2004, 53, 201-209) The passage of the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996, commonly known as welfare reform, changed how the government supports low-income families. This legislation changed 61 years of guaranteed benefits to eligible mothers and children, along with many services and programs for low-income families. The safety nets that once existed for these families have been removed and replaced with work-focused programs. In the aftermath of welfare reform, low-income families, perhaps more than ever before, must rely upon many sources within their environments in order to access the resources they need. With the implementation of welfare reform came many policy changes for those families receiving cash assistance and for families relying on other programs and services that changed, such as the Supplemental Security Income (SSI) program for children, Food Stamps, child support enforcement, childcare systems, and child nutrition programs. Recent studies have analyzed the impacts of welfare reform by looking at program outcomes using quantitative analysis, econometric methods, and secondary analyses of administrative data to investigate caseload decline, employment status, employment and earnings, welfare spells (Bell, 2001; Loprest, 1999; Weber, Duncan, & Whitener, 2001), and economic well-being (Porterfield, 2001; Weber et al). Although these macro-level studies give insight to general patterns and trends, the family perspective is missing-that is, the voices of families affected by policies often are muted in statistical reports. Instead of allowing families to talk about the triumphs and tribulations of their lives within a changing policy environment, previous studies have offered a generalized picture of their experiences. We argue that to understand the everyday unique experiences of families, policy researchers must begin with the family's perspective. As a decade review of literature on family policy research highlighted, the family's perspective has been virtually ignored (Bogenschneider, 2000). Moreover, few studies have taken the needed qualitative approach to understand the experiences from the perspectives of low-income families, with a few exceptions. Stack (1970) began from the family perspective by describing the survival strategies of a Black community through an ethnographic lens. Edin and Lein (1997) investigated the lived experiences of 379 urban low-income single mothers in four urban cities across the United States to understand how they pieced together the resources needed to meet the needs of their families. Newman (1999) offered an ethnographic view of inner-city poverty by letting families talk about their struggles to survive within their communities. Seccombe (1999) interviewed 47 women from small- and medium-sized communities in Florida to see their perspectives on welfare reform. Monroe and Tiller (2001) described the work of welfare-reliant women and their experiences with participants in the labor force, the rural job market, their use of support networks, and the stigma of welfare. Although these studies provide insight into the everyday experiences of low-income families, missing are those from rural low-income families. Previous studies have focused on urban low-income families or combined all families together, so the impact of one's location as low income was ignored. Rural low-income families face unique challenges due to the variability in availability and affordability of resources to help them get what they need (Lewis, 2000). …

This article evaluates a policy change from universal to means-tested child allowances in terms of targeting efficiency and poverty reduction, taking the introduction of the latter form of benefits in Russia as a case-study. We use the Russia Longitudinal Monitoring Survey (RLMS) from 2000 to 2004 to analyse the impact of the reforms and to simulate the effects of various means-tested and universal child benefit schemes. Since the reforms in 2000, more children have received benefits and there has been improved targeting of low income households. Nevertheless, both inclusion and exclusion errors are considerable and although the poverty reduction impact has improved marginally since the reforms, its effect on child poverty has been small. Our simulations show that universal schemes achieve additional poverty reductions with regard to all indicators because previously excluded children now also receive a benefit. However, size matters most: only by increasing benefit levels considerably can more substantial poverty reductions be achieved.

The study investigated lived experiences of single parent families of a high density suburb in Masvingo province, Zimbabwe. The qualitative approach utilising a descriptive survey was employed to study the phenomena. The population of the study comprised of female headed households. Households and respondents were sampled using convenience and purposive sampling. Data was collected through questionnaires, semi structured interviews and non participant observation. The data was presented and analysed in narrative form basing on the research questions and the themes which emerged. The findings from the study revealed that the extended family was an important factor in single parent families. The findings also revealed that fulfilment of family functions; physical, emotional, and psychological is sometimes a challenge in single parent families. The study established that to a greater extent the absence of one parent may contribute towards poor emotional and social development of the children. The study also established that the population studied experienced work overload, economic hardships and loneliness, especially the parents. The study recommends that single parents should form support groups where they share ideas on addressing challenges they face. The study also recommends community and extended family involvement in child rearing to provide role models in the place of the absent parent. Replica studies be conducted on single parents in other contexts to provide a holistic picture of single parenting and measures to minimise negative effects on children and parents.

Parents' perceptions of diabetes in adolescent daughters and its impact on the family.

Supportive parenting programs can promote parent-child interactions and children's development. However, families experiencing vulnerability (e.g., low socioeconomic status) report barriers (e.g., transportation, distrust of researchers) to research participation, and attrition rates of 40% and higher have been reported in parenting research. In response, we conducted a longitudinal evaluation of a digital parenting program in a major metropolitan centre in western Canada and retained 99% of our sample. Review recruitment and retention strategies employed in the First Pathways study and evaluate associations between sociodemographic (e.g., income) and psychosocial (e.g., parental depression) factors with recruitment and retention strategies. In collaboration with community agencies, we commenced recruitment of 100 families experiencing vulnerability (e.g., low-income) in June 2021. We utilized strategies to engage staff (e.g., presentations, gift cards, updates) and employed snowball sampling. Families recruited through community agencies were significantly more likely to experience vulnerability (e.g., low income and education, high adverse experiences) compared to families in the snowball sample. We incorporated strategies to minimize participant burden (e.g., choice of online or in-person meetings), promoted rapport (e.g., holiday texts, nonjudgmental environment), incorporated trauma-informed practices (e.g., sensitive inquiry), and demonstrated appreciation for participants' contributions (i.e., honorarium). Family experiences of vulnerability (i.e., low income, depressive symptoms, adversity) were correlated with higher participant rescheduling. Nurses need knowledge of strategies to promote equitable access to research for families experiencing vulnerability. Digital programs with protocols designed to establish rapport, include trauma-informed practices, and minimize participant burden will likely optimize participation and retention.

COVID-19 has grossly impacted lives of people across the globe. In particular, children have also been affected due to closure of schools, therapy, and day care centers. Families have been challenged with new circumstances, and mental health professionals are coming up with novel ways to help these families who have children with mental health issues. This article describes experiences of families who have children with a diagnosed neurodevelopmental disorder with comorbid mental health difficulties and their ways of coping with the pandemic challenges. The series will throw light on ground level experiences of families during the pandemic, give insights into their ways of adapting, and brings out problem areas which healthcare professionals must work on, to design novel ways of care. The case series is novel and a similar report has probably not been presented from India or other low and middle income countries.

Due to the higher autism research presence of higher-income countries, the known social and cultural experiences of families raising a child with autism are centered on their realities. This narrative overlooks the experiences of many families who do not fit this archetype, such as those residing in low- and middle-income countries, who are particularly challenged by the limited availability of trained professionals and barriers to accessing diagnosis and evidence-based treatments. That is the case in Latin American countries, such as Uruguay, where the present project transpires. By utilizing a Theory of Change framework, specifically developed to be used in low- and middle-income countries, the present study explores diagnostic and service barriers in Uruguay. The study included semi-structured interviews with caregivers of autistic individuals and key informants residing in Uruguay. Participants were selected using a purposive sample technique. Data analysis consisted of reflexive thematic analysis. Salient themes consisted of multiple barriers to diagnostic and service access due to a multistep process, limited awareness of autism characteristics, a hesitancy to provide a diagnosis, and few professionals who specialize in autism. For those residing outside the capital, additional difficulties were experienced.Lay AbstractCountries with higher monetary means to conduct research are able to have not only better knowledge of the realities of autistic individuals and their families but also better access to diagnostic and intervention services. In countries with lower income, there is limited understanding of autistic experiences and also issues with access to services due to multiple reasons, like services only being accessible in certain regions, few trained professionals, and long waitlists. This study seeks to understand possible diagnostic and service barriers experienced by autistic individuals residing in Uruguay. To understand the local realities, parents and specialists working with autistic individuals were interviewed, and the information gathered was analyzed by finding patterns that were used to form themes that included the shared experiences among participants. Some of the themes that were identified included reports of difficulties in accessing diagnosis and interventions, either because there were many steps needed to guarantee these services or because there was a limited awareness of autism spectrum disorder and its characteristics by providers, which resulted in a hesitation to diagnose. Also, participants described very few professionals who specialize in autism spectrum disorder. For those residing outside the capital, additional difficulties were experienced.

Comments [Return to Article] Jens Ludwig: There is widespread belief that a person's neighborhood of residence affects labor market outcomes, particularly for low-skilled minority workers living in central cities. This view stems from the results reported in a large body of theoretical and empirical research from across the social sciences. Yet the conclusion that neighborhoods matter for labor market outcomes seems to stand in sharp contrast to research on the Moving to Opportunity (MTO) randomized mobility experiment, which shows little impact on work or earnings measured four to seven years after random assignment.1 I consider ways of reconciling these conflicting strands of research as well as the implications for public policies designed to improve the labor market prospects of disadvantaged workers. I focus on three of the leading explanations that have been offered to explain why findings from MTO conflict with most people's reading of the existing literature on neighborhood effects: 1) the possibility that MTO did not generate large enough differences in neighborhood environments to affect outcomes; 2) whether estimates of neighborhood effects on the MTO population, which consists of the subset of public housing families who volunteered for the demonstration, generalize to other groups; and 3) the possibility that the effects of mobility on labor market outcomes become more pronounced over time. This paper by Turney and her colleagues provides useful information on these candidate explanations in the form of detailed, qualitative accounts of MTO families' experiences in the Baltimore demonstration site. After discussing previous hypotheses to reconcile MTO with existing research in light of findings from this work and other studies, I consider the evidence on another explanation that seems to have received less discussion—the possibility of bias with the previous nonexperimental research. [End Page 173] Did MTO Change Neighborhoods Enough? It is natural to wonder whether MTO actually changed neighborhoods enough to plausibly affect labor market or other outcomes. After all, of those families assigned to the MTO experimental group, only a fraction moved through the MTO program (58 percent in the Baltimore demonstration site). Experimental-group families were only required to live in their new low-poverty neighborhoods for one year, at which point they were free to use their vouchers to relocate to higher-poverty areas, which many chose to do. In addition, some control-group families wound up moving to neighborhoods with lower poverty rates over time on their own or as a result of HUD demolitions of public housing projects. Nevertheless, there are at least three reasons to believe that MTO generated important changes in the neighborhood environments of program participants, and therefore has something useful to say about the neighborhoods' role on labor market outcomes. First, across all five MTO cities, assignment to the experimental (rather than control) group reduced poverty rates by about 15 percent of the control group average in the tracts in which families were living four to seven years after random assignment (see table 1). In the Baltimore MTO site the experimental-control difference is more like 20 percent of the control mean for tract poverty, almost as large (17 percent) for tract employment rates, and more than twice as large (42 percent) as a share of the control mean for the presence of affluent (college-educated) adults in the neighborhood. These across-group differences pool together the experiences of families in the experimental group who did and did not move through MTO. The impact on those families who actually moved through the experimental MTO treatment in Baltimore will be about 1.7 times as large as the overall across-group differences.2 The one exception to this general pattern of MTO-induced changes in neighborhood attributes is for racial integration, which was more modestly affected by the MTO experimental treatment. A second reason to believe that MTO generated important changes in neighborhood environments is that MTO participants themselves perceive important differences in their neighborhood environments, as suggested by [End Page 174] the qualitative interviews described by this...

Objectives. To understand the experiences of families with low income in California with pandemic safety net support expansions and retractions, including barriers to program access. Methods. Using open-ended questions, we explored the self-reported experiences of pandemic-era safety net expansions and expirations between January and June 2023 among a group of caregivers of young children (n = 44). We used the Immersion-Crystallization technique to analyze the data, creating a codebook and identifying themes as they emerged. Results. We identified 4 main themes, including appreciation for safety net expansions, varied experiences because of the timing of supports, challenges meeting basic needs after expirations, and administrative burdens significantly impairing program access. Conclusions. The study themes highlighted how expansions to policies like the Child Tax Credit and Supplemental Nutrition Assistance Program improved food and housing security, and that unpredictable benefits, although appreciated, also added stress. Public Health Implications. State and federal policymakers should consider the poverty reduction and food and housing security benefits of expansions to pandemic-era supports that have expired when crafting future policy. They should pay special attention to addressing administrative barriers to reduce poverty-related health inequities. (Am J Public Health. 2025;115(11):1836-1847. https://doi.org/10.2105/AJPH.2025.308201).

ABSTRACTDoing work that is characterized by instability and low incomes, Japanese male part-time workers often remain in the natal home well into adulthood even in cases where there is considerable discord and where familial bonds are strained or complicated. Through detailed case studies this article examines how, for some male part-time workers, a desire to disconnect from familial kin in the search for individual autonomy leads to the creation of alternative forms of relatedness. Meanwhile, for others, pressure to work in particular ways combined with the negotiations of complex family relationships – especially with (male) heads of households – contributes to alienation from family and society. Although work status is not the only cause of family strain, gendered work expectations and labour pressures considerably contribute to discord and can lead to significant experiences of social exclusion and disconnection from the family and wider society.

This article investigates how communities experiencing poverty can exercise their deliberative agency in a media-saturated society. While empirical research on deliberative democracy tends to focus on the role of mini-publics in giving low-income households the opportunity in small-scale, carefully designed forums to characterise, justify, and reflect on their views, such conception of deliberative agency gets lost in the picture once deliberative theory begins thinking in systemic terms. This article proposes a remedy to this theoretical and analytical gap by characterising the hypermediated character of the deliberative system and identifying possibilities for communities experiencing poverty to maximise the affordances of digital media for them to make an appearance in the public sphere, speak in their own voice, and carry the embodied and storied character of their arguments. I present two illustrative cases drawing on the experiences of families with low income directly affected by the bloody war on drugs in the Philippines who utilise photojournalism and online music streaming to break in the public sphere and engage in systemic deliberations about the drug war. These examples demonstrate how communities experiencing poverty express their deliberative agency amidst fear, trauma and deprivation and democratise a media-saturated deliberative system under an increasingly authoritarian regime. Overall, this article hopes to strengthen the link between normative media studies and democratic theory and offering possibilities for reforming the public sphere that recognises the poor’s deliberative agency.

Drawing upon data from Changing Realities, an online participatory research project collected between September-October 2022 and March-April 2023, this article generates new knowledge on the lived experiences of low-income families in the UK during this turbulent political period and particularly through the (ongoing) cost-of-living crisis. Utilising the work of Wright and McIntosh, we articulate the ‘shared typical’ discernible of lived experiences of life on a low income during this tumultuous period. Findings provide new insights into how participants describe themselves as part of a collective, comprising parents and carers who shared similar experiences of life on a low income. However, in contrast they differentiated between themselves and those in positions of power and disconnected from their reality. In our discussion, we examine the implications of this and consider the broader understandings and realisations of poverty.

IntroductionIn Australia, access to insulin pump therapy for children with type 1 diabetes (T1D) is predominantly restricted to families with private health insurance. In an attempt to improve equity, additional subsidised pathways exist which provide pumps to families with reduced financial resources. We aimed to describe the outcomes and experiences of families with children commenced on pumps through these subsidised pathways in Western Australia (WA).MethodsChildren with T1D in WA who did not have private health insurance and received pumps from the subsidised pump programs between January 2016 and December 2020 were included. Study 1 was designed to review glycaemic outcome. A retrospective analysis of HbA1c was conducted in the whole cohort and in children who commenced pump after the first year of diagnosis to exclude the impact of the partial clinical remission phase following diagnosis. HbA1c at baseline, and six, 12, 18 and 24 months after pump initiation were collected. Study 2 was designed to review experiences of families commenced on pumps through subsidised pathway. A questionnaire designed by the clinical team was distributed to parents via an online secure platform to capture their experiences.ResultsOf the 61 children with mean (SD) age 9.0 (4.9) years who commenced pump therapy through subsidised pump programs, 34 children commenced pump therapy after one year of diagnosis of T1D. The median (IQR) HbA1c (%) in 34 children at baseline was 8.3 (1.3), with no statistically significant change from baseline at six months [7.9 (1.4)], 12 months [8.0 (1.5)], 18 months [8.0 (1.3)] or 24 months [8.0 (1.3)]. The questionnaire response rate was 56%. 83% reported intention to continue pump therapy, however 58% of these families did not have avenue to acquire private health insurance. Families expressed inability to procure private health insurance due to low income and unreliable employment and remained largely unsure about the pathway to obtain the next pump.DiscussionChildren with T1D who commenced insulin pump therapy on subsidised pathways maintained glycaemic control for two years, and families favored pumps as a management option. However, financial limitations persist as a significant barrier to procure and continue pump therapy. Pathways for access need to be assessed and advocated.